Obsessive Compulsive Disorder

Have you ever had a strange or unusual thought just pop into your mind that is entirely out of character for you? Maybe you’ve had the thought of suddenly blurting out an embarrassing or rude comment, or of causing harm or injury to another person, or of doubting whether you acted correctly in a particular situation.

Have you had an irresistible urge to do something that you know is entirely senseless, like checking the door even though you know it is locked, or washing your hands even though they are clean?

Most people experience unwanted, even somewhat bizarre or disgusting thoughts, images and impulses from time to time. We don’t feel upset by these thoughts and urges, even though they seem pretty unusual for our personality and our experience.
Some individuals, however, suffer with a special type of unwanted thought intrusion called obsessions. Obsessions are recurrent and persistent intrusive thoughts, images or impulses that are unwanted, personally unacceptable and cause significant distress.
Even though a person tries very hard to suppress the obsession or cancel out its negative effects, it continues to reoccur in an uncontrollable fashion.

Obsessions usually involve upsetting themes that are not simply excessive worries about real-life problems but instead are irrational concerns that the person often recognizes as highly unlikely, even nonsensical.

The most common obsessional content involve(a) contamination by dirt or germs,(b) losing control and harming oneself or other people,(c) doubts about one’s verbal or behavioural responses,(d) repugnant thoughts of sex or blasphemy,(e) deviations from orderliness or symmetry,(f) the possibility of sudden sickness (e.g., fear of vomiting), or(g) the need to save even the most useless objects.

I couldn’t do anything without rituals.

Compulsions are repetitive, somewhat stereotypical behaviours or mental acts that the person performs in order to prevent or reduce the distress or negative consequences represented by the obsession. Individuals may feel driven to perform the compulsive ritual even though they try to resist it.

Typical compulsions include repetitive and prolonged washing in response to fears of contamination, repeated checking to ensure a correct response, counting to a certain number or repeating a certain phrase in order to cancel out the disturbing effects of the obsession.

Over 90% of people with clinical OCD have both obsessions and compulsions, with 25% to 50% reporting multiple obsessions.
Approximately 1% to 2% of the Canadian population will have an episode of OCD, with the possibility that slightly more women experience the disorder than men. The majority of individuals report onset in late adolescence or early adulthood, with very few individuals experiencing a first onset after 40 years of age.

OCD is also seen in childhood and adolescence where it is a similar symptom pattern to that seen in adults. OCD tends to be a chronic condition with symptoms waxing and waning in response to life stresses and other critical experiences. It is uncommon for individuals to spontaneously recover from OCD without some form of treatment.

Depending on the severity of the symptoms, OCD can have a profound negative impact on functioning. In severe cases, obsessive thoughts and repetitive, compulsive rituals can consume one’s entire day. Like other chronic anxiety disorders, OCD often interferes with jobs and schooling. Social functioning may be impaired and relationships can be strained as family and close friends get drawn into the individual’s OCD concerns.

The actual cause of this disorder is not well known. Genetic factors may play a role but to date there is little evidence of a specific inheritance of OCD.

Studies have suggested there may be some abnormalities in specific regions or pathways of the brain. Other research indicates that critical experiences or personality predispositions might be related to increased susceptibility for OCD.

However, there is no known single cause to OCD. Instead, most of the genetic, biological and psychological causes probably increase susceptibility to anxiety in general rather than to OCD in particular.

I. What are the Symptoms of Obsessive-Compulsive Disorder?

presence of obsessions and/or compulsions; person recognizes that the obsessions or compulsions are excessive, unrealistic, even senseless, at some point during the course of the disturbance;

obsessions and compulsions cause marked distress, are time consuming, or significantly interfere in daily activities;

the content of the obsessions and compulsions is not restricted to concerns associated with another psychological disturbance such as the preoccupation with food in an eating disorder or guilty ruminations in major depression, nor are the symptoms directly caused by the physiological effects of a substance or general medical conditions.

upsetting and reoccurring thoughts or images

unstoppable images or thoughts

unstoppable repetition of actions such as

counting

checking on things

washing hands

re-arranging objects

doing things until it feels right

collecting useless objects

worries about terrible consequences unless certain actions are performed

unwanted urges to hurt someone, but knowledge that they could never be carried out

II. What is OCD?

Obsessive-compulsive disorder (OCD) is characterized by anxious thoughts or rituals you feel you can’t control. If you have OCD, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.

The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or dispel them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the discomfort caused by the obsession.

A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life.

Most adults with this condition recognize that what they’re doing is senseless, but they can’t stop it. Some people, though, particularly children with OCD, may not realize that their behaviour is out of the ordinary.

OCD strikes men and women in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children. The course of the disease is variable–symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families.

Depression or other anxiety disorders may accompany OCD. Some people with OCD have eating disorders. In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn’t develop to those extremes.

III. Is OCD Serious?

People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals such as handwashing, counting, checking, or cleaning are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person’s life. OCD is often a chronic, relapsing illness.

OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit hyperactivity disorder, or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Symptoms of OCD can also coexist and may even be part of a spectrum of neurological disorders, such as Tourette’s syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.

IV. What Causes OCD?

There is growing evidence that OCD has a neurobiological basis. OCD is no longer attributed to family problems or to attitudes learned in childhood – for example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioural therapy and medication produce changes in the caudate nucleus, a part of the brain. This is graphic evidence that both psychotherapy and medication affect the brain.

V. What Treatment is Available for OCD?

What Psychological Approaches Are Used To Treat OCD?

Since the early 1970s research has shown that behaviour therapy is the most effective treatment for most types of OCD. It involves experiencing the fearful situations that trigger the obsession (exposure) and taking steps to prevent the compulsive behaviours or rituals (response prevention).

These studies have shown that 76% of individuals who complete treatment (13-20 sessions) will show significant and lasting reductions in their obsessive and compulsive symptoms.

When measured against other treatment approaches such as medication, behaviour therapy most often produces stronger and more lasting improvement. In fact, there may be little advantage to combining behaviour therapy and medication given the strong effects of the psychological treatment.

Behavioural therapy, specifically a type called exposure and response prevention, has also proven useful for treating OCD. It involves deliberately and voluntarily exposing the person to whatever triggers the problem and then helping him or her forego the usual ritual–for instance, having the patient touch something dirty and then not wash his hands. Studies of behaviour therapy for OCD have found it produces long-lasting benefits. To achieve the best results, a combination of factors is necessary: The client must be highly motivated; and the client’s family must be cooperative. In addition to visits to the therapist, the client must be faithful in fulfilling “homework assignments”. For those who complete the course of treatment, the improvements can be significant, though results have been less favourable in some people who have both OCD and depression.

However, up to 30% of people with OCD will refuse behaviour therapy or drop out of treatment prematurely. One of the main reasons for this is a reluctance to endure some discomfort that is involved in exposure to fearful situations. As well, certain types of OCD such as hoarding or rumination without overt compulsion may not respond as well to behaviour therapy.
More recently, psychologists have been adding cognitive interventions to the behaviour therapy treatments involving exposure and response prevention. Referred to as cognitive behaviour therapy, this approach helps people change their thoughts and beliefs that may be reinforcing obsessive and compulsive symptoms.

Together with exposure and response prevention, this new approach has been shown to be effective in offering hope to individuals suffering from OCD.